产褥期不同部位腹直肌间距及分离的超声评价与相关风险因素分析

Ultrasound evaluation and related risk factor analysis of the diastasis recti abdominis in different parts during the postpartum period

目的通过超声测量产后6周女性不同位点的腹直肌间距(IRD),探讨产后腹直肌分离(DRA)的高发部位与发病类型,并分析相关风险因素。方法选取1247例产后6周行腹直肌超声检查的产妇,收集产妇及胎儿一般临床资料,于脐上3 cm、脐部、脐下3 cm三个部位测量IRD,诊断是否存在DRA,按照发生部位与数目分组。采用逐步回归、单因素及多因素logistic分析方法分析IRD与DRA的影响因素。结果产后6周脐上3 cm处、脐部、脐下3 cm处IRD分别为(24.63±9.41)、(26.72±9.38)、(9.40±8.22)mm。1173名(94.06%)产妇发生DRA,单部位者156例(12.51%),同时合并两部位者318例(25.50%),全腹型者699例(56.05%)。剖宫产、怀孕次数、新生儿体质量指数(BMI)、产前BMI及生产孕周或产妇年龄影响三部位IRD(P<0.05)。剖宫产、产前BMI是发生两部位DRA的风险因素(OR=16.140,OR=1.152,P<0.01);剖宫产、新生儿BMI与产前BMI是发生全腹型DRA的危险因素(OR=19.987)。结论超声测量产后6周的IRD与多种因素相关,其中剖宫产是DRA的高风险因素,当合并影响因素增多,全腹型DRA发病风险增加。

Objective To explore the high-risk sites and types of diastasis recti abdominis(DRA)postpartum,and analyze related risk factors by measuring the inter-rectus distance(IRD)at different sites in women at 6 weeks postpartum using ultrasound.Methods A total of 1247 postpartum women who underwent ultrasound examination of the rectus abdominis at 6 weeks postpartum were selected,and general clinical data of postpartum women and newborns were collected.IRD was measured at three sites:3 cm above the umbilicus,umbilicus,and 3 cm below the umbilicus to diagnose the presence of DRA.DRA was grouped according to the site and number.Stepwise regression,and univariate and multivariate logistic analysis methods were used to analyze the influencing factors of IRD and DRA.Results At 6 weeks postpartum,IRD at 3 cm above the umbilicus,umbilicus,and 3 cm below the umbilicus were(24.63±9.41),(26.72±9.38),and(9.40±8.22)mm,respectively.DRA occurred in 1173(94.06%)postpartum women,156(12.51%)with single site,318(25.50%)with two sites at the same time,and 699(56.05%)with whole abdomen.Cesarean section,number of pregnancies,neonatal body mass index(BMI),prenatal BMI,and gestational week or maternal age affected IRD at three sites(P<0.05).Cesarean section and prenatal BMI were the risk factors for two-site DRA(OR=16.140,OR=1.152,P<0.01).Cesarean section,neonatal BMI,and prenatal BMI were the risk factors for whole abdominal DRA(OR=19.987).Conclusion IRD measured by ultrasound at 6 weeks postpartum is associated with multiple factors,among which cesarean section is a high-risk factor for DRA.When combined with more influencing factors,the risk of developing whole abdominal DRA increases.